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Column: How to sort health care policy fact from fiction

BY MICHELLE SINGLETARY Columnist

Aug 26 2013 12:01 am Sep 4 2:12 pm

Editor's note: This is the second column in an occasional series from Washington Post financial columnist Michelle Singletary about the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.

I've had health care coverage throughout my working life. The most I've had to contend with has been the increasing amount of co-payments. And even then, they've been affordable.

But having insurance hasn't kept me from understanding the plight of people whose employers didn't offer coverage. I've witnessed and tried to console folks worried that a health crisis could bankrupt them. I've become concerned when people I know have lost their jobs and couldn't afford to carry insurance on their own.

The Patient Protection and Affordable Care Act is supposed to open the door to health care for millions of people starting Jan. 1 though a Health Insurance Marketplace. But confusion abounds. As we get closer to that day, people are trying to sort fact from fiction.

I'll answer the questions as best I can with the help of experts. But you can find a lot of answers at www.healthcare.gov, a website of the Department of Health and Human Services.

Right now, a lot hasn't been worked out. Still, Health and Human Services has done a good job walking people through the law considering how complicated it is. But be patient. The most important information you want to know – how much your insurance will cost – isn't posted yet. Specific plans and prices won't be available until Oct. 1, when open enrollment begins. But the October date isn't a deadline. You will have time to shop around.

When open enrollment begins, you will either apply using healthcare.gov or a site managed by your state. I live in Maryland. The Maryland Health Connection is the Health Insurance Marketplace that would serve me should I lose coverage. Instead of going to healthcare.gov, I would use the Maryland Health Connection website to compare plans and apply for coverage.

Aside from cost, don't wait to get your other questions answered. Here's one from a reader that I forwarded to Health and Human Services: “My child is currently unemployed, but has health insurance on my policy because of the ability to buy COBRA. It is very expensive. Will he be able to use the exchanges immediately, or does he need to wait until the COBRA expires, become uninsured, and then use an exchange? He has a pre-existing condition that makes buying a policy difficult.”

Here's how Health and Human Services answered the question. If the mother has insurance and the son is under 26, he should be able to join her insurance without going the COBRA route – just adding him as part of a family plan. Under COBRA, people can continue to get coverage at their former employer's group rates. But they have to pay the full premium, including the share that the employer used to pay, plus a 2 percent administrative fee. This makes COBRA unaffordable for many people. But if this mother is paying for her coverage on COBRA but it's too expensive to add her son, he can shop for health care on the marketplace.

By the way, starting next year, there will be a ban on denying coverage for pre-existing conditions. The agency said the only thing that the young man wouldn't be eligible for is tax credits if he has an offer of affordable coverage through an employer. “It sounds like that's not the case, so he would likely be eligible for tax credits or Medicaid coverage, depending on their specific situation,” Health and Human Services said.

Another question from a reader: “What happens to a working family that has employment but at the same time can't afford even the cheapest policy just because at the present time they don't have the resources for even a modest plan?

The department's answer: “If they have offers of employer-sponsored insurance, but none are affordable (as in, they would cost more than a certain percentage of the family's annual income), then families can buy insurance with subsidies on the exchanges. If the person is asking about exchange coverage being affordable, they need to consider that most families will be eligible for tax credits that could dramatically reduce the cost of a plan for a family and they will be able to see the tax credits that they're eligible for when they're shopping for coverage.”

There's a live chat option that I encourage you to use at www.healthcare.gov/help-center. You should not provide any personal information such as your Social Security number or any other sensitive medical or personal information on the chat.

So, if you're fretting about something you heard on the news, go online or call for assistance. Help is available around the clock.

Michelle Singletary is a personal finance columnist for The Washington Post.

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